Inspection

Signs of COPD
1 Inspiratory descent of trachea.
2 Use of accessory muscles.
3 Pursed lips on exhalation (provides a small amount of PEEP).
4 Increased AP diameter (barrel chest).
a Normal in infancy and increased with aging.
5 Prominent angle of Louis (or sternal angle).
6 Flaring of the lower costal margins.
7 Dahl Sign: Above the knee, patches of hyperpigmentation or bruising caused
by constant 'tenting' position of hands or elbows.
8 Hoover's sign: briefly, during inspiration a paradoxical medial movement of
the chest.
a The "subcostal angle" is the angle between the xiphoid process and the
right or let costal margin. Normally, during inhalation the chest
expands laterally, increasing this angle. When the diaphragms are
flattened (as in COPD), inhalation paradoxically causes the angle to
decrease.
9 Harrison's sulcus: a horizontal grove where the diaphragm attaches to the
ribs; associated with chronic asthma, COPD, & Rickets.
REMEMBER : "The side that moves less, is the side of disease!"
Look for signs of volume loss (or gain) on the side that moves less(hollow
supraclavicular fossae, intercostal spaces prominent, shoulder droopy, scapula
outline more prominent).